Healthcare Provider Details

I. General information

NPI: 1548467525
Provider Name (Legal Business Name): JASON BARTLEY D.P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2007
Last Update Date: 01/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RAF LAKENHEATH 48 MDG UNIT 5115
APO AE
09461-5115
US

IV. Provider business mailing address

PSC 37 BOX 4231
APO AE
09459-0043
US

V. Phone/Fax

Practice location:
  • Phone: 011441638528124
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: